血乳酸联合体质量指标指导重度脓毒症患者补液的可行性探讨  

Feasibility study about fluid replacement for severe septic patients with the guidance of blood lactate and weight

作　　者：田锁臣[1] 张喜红[1] 刘志军[1] 吴铁军[1] 

机构地区：[1]聊城市人民医院ICU,山东252000

出　　处：《中国急救医学》2010年第9期832-834,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的 探讨用血乳酸及体质量指标联合指导重度脓毒症患者液体复苏的可行性.方法 收集2007-05～2009-05入住ICU的重度脓毒症患者92例,随机分为正常治疗组（46例）和试验组（46例）.正常治疗组在完成早期复苏目标导向治疗（EGDT）后,仍严格按照EGDT指标给予补液;试验组在完成EGDT目标后,除继续满足EGDT指标平均动脉压（MAP）、尿量、中心静脉氧饱和度（ScVO2）外,弱化中心静脉压（CVP）的监测,重点参考血乳酸及体质量的动态改变补充液体,观察记录监测指标.结果 正常治疗组ICU住院时间、机械通气时间、转入第96 h APACHE Ⅱ分值、96 h内晶、胶体补液总量、死亡率分别是（8.23±1.80）d、（5.39±0.85）d、（10.32±1.28）分、 （19 430±2973.98） mL、36.96%;试验组分别是（60.05±1.73）d、（4.08±0.87）d、（8.26±0.90）分、（15 129±1977.81）mL、17.39%,两者比较差异均有统计学意义.结论 重度脓毒症患者,在完成EGDT后,引入血乳酸及体质量指标联合指导补液是可行的.Objective To discuss the feasibility of fluid replacement for severe septic patients with the guidance of blood lactate and weight. Methods 92 severe septic patients in our ICU from May 2007 to May 2009 were collected. All the patients were randomly divided into normal group （46 cases） and experimental group （46 cases）. Fluid replacement was strictly supplied according to the indexes of early goal- directed therapy （EGDT） after completing the index of EGDT for the patients of normal group. In experimental group, the monitoring of central venous pressure （CVP） was attenuated, and fluid replacement was supplied according to mainly referring to dynamic change of blood lactate and weight besides keeping the indexes of mean arterial blood pressure （MAP） , urine output, systemic central venous oxygen saturation （ScVO2 ） . The monitoring indexes were observed and noted. Results In normal group, days in ICU, length of mechanical ventilation, 96 h APACHE Ⅱ score, crystalloid and colloid fluid total amount within 96 h, mortality rate were （8.23 ±1.80） days, （5.39 ± 0.85 ） days, （ 10.32 ± 1.28）, （ 19 430 ± 2973.98） mL, 36.96%. In experimental group, they were （6.05 ± 1.73） days, （4.08 ± 0.87） days, （ 8.26± 0. 90）, （ 15 129 ± 1977.81 ） mL, 17.39% respectively. There were statistical significances between two groups. Conclusion It is feasible for severe septic patients to direct fluid replacement with the guidance of blood lactate and weight.

关 键 词：乳酸 体质量 重度 脓毒症 补液 

分 类 号：R572[医药卫生—消化系统]